Strains involving the back of your thigh muscles, the hamstring muscles, are common in sports and certain daily activities that may cause a strong contraction or stretch to the muscles. A strain means a tear, which can be minor, or large to a complete rupture. However, much too often, people are diagnosed with a hamstring strain, when the source of their problem lies elsewhere.

True hamstring strains occur when a muscle is contracted very strongly and often quickly, such as with sprinting, and in particular if fatigued, or if a muscle is either suddenly stretched with force, or gradually overstretched through prolonged 30-60 second holds, a common reason for strains in dancers. When pain in the muscle develops gradually, and without any apparent incident, it is much less likely that the muscle itself is the real problem, even if an MRI scan e.g. has shown signs interpreted as a “degenerative tear”, not uncommonly seen near the hamstring attachment onto the “sit bone” below the buttock.

In many cases of such “mysterious strains”, it is not easy to make a correct diagnosis at first. We then find that the hamstring muscles are often tender to touch, and tight feeling when we try to stretch or contract the muscle. Flexibility of the muscle is typically reduced. But a clinical examination involving specific testing of muscle contraction, stretch and palpation (to feel and apply pressure with your fingers) usually does not reveal the typical pattern seen in true muscle strains.

The most common cause of these symptoms is some disorder involving the lower back, such as a disc bulge or degeneration, facet joint disorder or instability, and/or nerve root irritation in the back, setting off a reflex muscle guarding response in the hamstrings. This is common with problems in the L4-5 or L5-S1 areas of the lower back. These people often have a history of low back issues, but may currently only feel the hamstring muscles, and not the back. When a nerve in the lower back gets irritated, this “muscle pain” and tightness can be particularly bothersome, especially when stretched by bending forward, or lifting the leg straight up.

If this is the case, rehabilitation aimed at healing the “muscle strain” will typically fail, and may worsen the pain. Such treatment would usually involve gradually progressed resistive exercises and over time gentle muscle stretching. However, if the source of the excessive muscle tension (and discomfort) lies in the lower back, such treatment can never produce lasting improvement, and if a nerve in the back is irritated, the treatment would worsen the pain.

Rather, the treatment should target the lower back, with hands on soft tissue and joint mobilization, as indicated, and gradually progressed rehabilitation exercise for the lower back. Gentle soft tissue techniques for the hamstrings can offer some pain relief, and is appropriate as long as the muscle is not being stretched at an early stage.

It is always a good idea in these types of cases to prior to starting treatment, have a comprehensive and specific evaluation by a rehabilitation specialist, regardless of the medical diagnosis. After 37 years in clinical practice, I can attest to the importance of individualizing treatment for all patients, and in these cases closely monitor the response to treatment, and make modifications accordingly, as indicated.